| NPI | 1639364680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 080940) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 080240-1) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2015-04-28 |